The Alignment of the Nose in Rhinoplasty: Fix Down Concept

Overview

The author argues rhinoplasty literature concentrates on the profile view while the nose is three-dimensional. This paper introduces the fix down concept, a technique plus supporting maneuvers intended to align the nose in the front, base and profile views and improve symmetry.

Sections of note

• 102 patients, 78 women and 24 men, 13 revision and 89 primary cases, underwent septorhinoplasty with the fix down concept between March and December 2017.
• Noses were evaluated in coronal, sagittal and axial planes and classified by their deformities.
• Functional and aesthetic results were reported as satisfactory to patients, examiners and surgeon.
• No revisions were necessary during the follow-up period, whose length is not stated in the abstract.
• Adjunct maneuvers used: ethmoid bone grafting 16 patients, fix up technique 8, dissection of the levator labii superioris alaeque nasi muscle 14, plication of that muscle 4.
• Also used: superior-based transposition flap 39, rim grafts 17, mucosa grafts 12, double-layer grafts 9.
• Also used: maxillary deepening 5, maxillary augmentation with cartilage or bone grafts 21, supratip onlay grafts 7. Level of evidence IV.

What it means for a patient

• Planning is done from the front and from below as well as from the side, so asymmetries visible only in those views are addressed.
• Most patients received several additional maneuvers alongside the core technique.
• The muscle running from the upper lip to the nostril was dissected or folded in 18 of 102 patients, addressing its pull on the nose.
• Limits: one surgeon, retrospective, no comparison group, no stated follow-up duration, and outcomes described qualitatively without scores.

Why this paper matters

Symmetry in the frontal and base views is what patients notice and what profile-focused technique can miss. Setting out a systematic three-plane approach addresses that gap. Reporting no revisions without a stated follow-up length or objective measurement limits how the claim can be read.

Terms

• Coronal, sagittal and axial planes: The front, side and horizontal views of anatomy.
• Septorhinoplasty: Combined reshaping of the nose and correction of the septum.
• Ethmoid bone: A thin bone forming part of the septum, usable as a graft.
• Levator labii superioris alaeque nasi: A muscle running from the cheek to the upper lip and nostril.
• Plication: Folding and stitching tissue to shorten or weaken it.